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This was also the case in an Australian study where Boorman et al (2013) looked at criteria for a traumatic birth in 890 women and found that prevalence of traumatic birth doubled from 14.3% to 29.4% when women’s emotional responses (criterion A2) were removed. However, only 19.7% of women reported both perceived threat of death or injury and feeling intense fear, helplessness or horror. Similarly, 35% of women reported feeling intense fear or horror at some point during birth. In the UK, Ayers et al (2009) looked at prevalence of postpartum PTSD in 502 women in community studies and found 35% of women reported perceived threat of injury or death. However two large studies carried out in the UK and Australia suggest the removal of A2 is likely to inflate prevalence rates of postpartum PTSD because many women perceive a threat of injury or death during birth. Postpartum PTSD research certainly supports the notion that women respond to traumatic birth with a wide range of negative emotions (e.g. anger, shame, guilt) and that inclusion of A2 “ proved to have no utility in predicting the onset of PTSD” (see APA factsheet). The rationale behind this change is that people respond to traumatic events in different ways (e.g. On the other hand, the removal of criterion A2 where the person has to respond to the event with intense fear, helplessness or horror could increase prevalence rates of postpartum PTSD. This tightening of event criteria to potentially exclude infant deaths, coupled with the necessity for parents to have four types of symptoms rather than three, means prevalence rates of postpartum PTSD could reduce. This raises the question of whether psychological problems arising from perinatal infant death are more appropriately conceptualised as PTSD or complicated grief. However, the exclusion of death of a family member by natural causes could (arguably) exclude death of the infant before, during or after birth, depending on how ‘natural causes’ is defined. Similarly, fathers and birth partners may fit criteria by witnessing such events.
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Traumatic births still fit criteria because women can directly experience the threat of death or injury.
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Two subtypes have been added of PTSD in children and PTSD with dissociative symptoms.įor perinatal PTSD the changes to event criteria are critical.Arousal symptoms now include more aggressive or self-destructive behaviours.The new category of ‘negative cognitions and mood’ includes some symptoms of numbing that were previously included with avoidance symptoms, in addition to new symptoms such as persistent blame of self or others. There are now four symptom clusters of PTSD instead of three: (1) intrusions, (2) avoidance, (3) arousal and (4) negative cognitions and mood.In addition, certain events are excluded from qualifying as a traumatic event, including the u nexpected death of a family member by natural causes.
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Previous criterion A2 about individuals responding to this event with intense fear, helplessness or horror has been removed. Event criteria have changed so the person has to directly experience or witness “actual or threatened death, serious injury or sexual violation”.PTSD is now classified as a ‘trauma and stressor-related disorder’ rather than an anxiety disorder.Nonetheless, the key changes outlined by the APA factsheet and gleaned from a few other sources are as follows: Frustratingly, getting access to the complete diagnostic criteria seems to be difficult unless you purchase the manual. Key changes in DSM-5 criteria for PTSD are outlined in an APA factsheet. So what are the implications of DSM-5 for perinatal PTSD? The British Psychological Society also expressed concerns about aspects of DSM-5, and the Division of Clinical Psychology published a detailed statement in response to DSM-5. In May this year the American Psychiatric Association released version 5 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to some controversy and criticism, including from Allen Frances, the chair of the previous DSM task force ( Psychology Today, 2012). By Susan Ayers, Centre for Maternal and Child Health, City University London